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Prototype Prescribing Outlier Dashboard for Almondsbury Surgery

At OpenPrescribing we are piloting a number of data-driven approaches to identify unusual prescribing and collect feedback on this prescribing to inform development of new tools to support prescribers and organisations to audit and review prescribing. These pilot results are provided for the interest of advanced users, although we don't know how relevant they are in practice. There is substantial variation in prescribing behaviours, across various different areas of medicine. Some variation can be explained by demographic changes, or local policies or guidelines, but much of the remaining variation is less easy to explain.

The DataLab is keen to hear your feedback on the results. You can do this by completing the following survey or emailing us at [email protected]. Please DO NOT INCLUDE IDENTIFIABLE PATIENT information in your feedback. All feedback is helpful, you can send short or detailed feedback.

This report has been developed to automatically identify prescribing patterns at a chemical level which are furthest away from “typical prescribing” and can be classified as an “outlier”. We calculate the number of prescriptions for each chemical in the BNF coding system, the count of all prescriptions within that chemical's BNF subparagraph, for prescriptions dispensed between June 2021 and December 2021. We then calculate the ratio of these counts along with the mean and standard deviation of those ratios across all Practices. From this we can calculate the “z-score”, which is a measure of how many standard deviations a given Practice is from the population mean. We then rank your “z-scores” to find the top 10 results where prescribing is an outlier for prescribing higher than its peers and those where it is an outlier for prescribing lower than its peers.

For each outlier chemical, a kernel density estimation plot of all Practice's chemical:subparagraph ratios is provided, with this Practice's ratio overlaid in red.

It is important to remember that this information was generated automatically and it is therefore likely that some of the behaviour is warranted. This report seeks only to collect information about where this variation may be warranted and where it might not, to inform research on this topic. Our full analytical method code is openly available on GitHub here.

This is a new, experimental feature. We'd love to .

Prescribing where Almondsbury Surgery is higher than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Spironolactone with loop diuretics 7 Potassium sparing diuretics and compounds 11 0.64 0.01 0.08 8.29
Ferric maltol 4 Oral iron 137 0.03 0.00 0.00 7.88
Doxycycline hyclate 1 Drugs for oral ulceration and inflammation 8 0.12 0.00 0.02 7.51
Hydromorphone hydrochloride 6 Opioid analgesics 786 0.01 0.00 0.00 6.25
Saxagliptin 45 Other antidiabetic drugs 326 0.14 0.01 0.02 5.48
Vancomycin hydrochloride 3 Some other antibacterials 4 0.75 0.05 0.13 5.25
Ibandronic acid 37 Bisphosphonates and other drugs 194 0.19 0.02 0.03 5.11
Choline salicylate 3 Drugs for oral ulceration and inflammation 8 0.38 0.03 0.07 4.90
Flupentixol hydrochloride 6 Antipsychotic drugs 138 0.04 0.00 0.01 4.88
Urea 18 Emollients 50 0.36 0.09 0.06 4.58

Prescribing where Almondsbury Surgery is lower than most

BNF Chemical Chemical Items BNF Subparagraph Subparagraph Items Ratio Mean std Z_Score Plots
Other emollient preparations 32 Emollients 50 0.64 0.89 0.07 -3.66
Fluconazole 5 Triazole antifungals 11 0.45 0.85 0.13 -2.97
Benzydamine hydrochloride 4 Drugs for oral ulceration and inflammation 8 0.50 0.84 0.16 -2.15
Zinc oxide 1 Soothing haemorrhoidal preparations 4 0.25 0.77 0.26 -2.04
Amoxicillin 206 Broad-spectrum penicillins 287 0.72 0.85 0.07 -2.00
Clotrimazole 29 Vaginal and vulval infections 39 0.74 0.90 0.09 -1.86
Mirtazapine 223 Other antidepressant drugs 597 0.37 0.57 0.10 -1.84
Carbomer 940/980 7 Tear deficiency, eye lubricant/astringent 97 0.07 0.34 0.15 -1.80
Betahistine hydrochloride 17 Drugs used in nausea and vertigo 222 0.08 0.27 0.11 -1.75
Sildenafil (Erectile Dysfunction) 124 Drugs for erectile dysfunction 201 0.62 0.77 0.09 -1.63